• EDISON SW 활용 경진대회 논문집
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• 제6회(2017년)
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• pp.628-630
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• 2017

관상동맥의 협착 병변의 위험성을 치료 및 예방하기 위하여 FFR(Fractional flow reserve)이라는 지표를 사용한다. 기존의 임상에서 FFR을 측정하기 위하여 침습적인 방법을 이용하여 진행하였다. 이러한 침습적 방법은 부작용의 위험성을 가지고 있기 때문에 컴퓨터 시뮬레이션을 통해 계산하면 위험성을 해소할 수 있다. 하지만 현재 컴퓨터 시뮬레이션은 CT image를 이용하기 때문에 칼슘을 정확히 구별하거나 지질의 위치 등을 확인하는 것이 어렵기 때문에 FFR 결과에 오류를 발생시킬 수도 있고, 또한 전체 관상동맥을 해석하기 때문에 많은 계산량이 필요하다. 본 연구에서는 최근 높은 해상도를 가진 OCT(Optical Coherence Tomography)를 이용하여 이러한 한계점을 극복하고자 하고, 임상에서 측정한 FFR과 OCT에서 측정된 FFR은 비교하는 것이 목적이다.

• Korean Circulation Journal
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• 제54권8호
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• pp.485-496
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• 2024

Background and Objectives: Angiographic assessment of coronary stenosis severity using quantitative coronary angiography (QCA) is often inconsistent with that based on fractional flow reserve (FFR) or intravascular ultrasound (IVUS). We investigated the incidence of discrepancies between QCA and FFR or IVUS, and the outcomes of FFR- and IVUS-guided strategies in discordant coronary lesions. Methods: This study was a post-hoc analysis of the FLAVOUR study. We used a QCA-derived diameter stenosis (DS) of 60% or greater, the highest tertile, to classify coronary lesions as concordant or discordant with FFR or IVUS criteria for percutaneous coronary intervention (PCI). The patient-oriented composite outcome (POCO) was defined as a composite of death, myocardial infarction, or revascularization at 24 months. Results: The discordance rate between QCA and FFR or IVUS was 30.2% (n=551). The QCA-FFR discordance rate was numerically lower than the QCA-IVUS discordance rate (28.2% vs. 32.4%, p=0.050). In 200 patients with ≥60% DS, PCI was deferred according to negative FFR (n=141) and negative IVUS (n=59) (15.3% vs. 6.5%, p<0.001). The POCO incidence was comparable between the FFR- and IVUS-guided deferral strategies (5.9% vs. 3.4%, p=0.479). Conversely, 351 patients with DS <60% underwent PCI according to positive FFR (n=118) and positive IVUS (n=233) (12.8% vs. 25.9%, p<0.001). FFR- and IVUS-guided PCI did not differ in the incidence of POCO (9.5% vs. 6.5%, p=0.294). Conclusions: The proportion of QCA-FFR or IVUS discordance was approximately one third for intermediate coronary lesions. FFR- or IVUS-guided strategies for these lesions were comparable with respect to POCO at 24 months.

• Korean Circulation Journal
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• 제52권1호
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• pp.47-59
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• 2022

Background and Objectives: The influence of pre-intervention coronary physiologic status on outcomes post percutaneous coronary intervention (PCI) is not well known. We sought to investigate the prognostic implications of pre-PCI fractional flow reserve (FFR) combined with post-PCI FFR. Methods: A total of 1,479 PCI patients with pre-and post-PCI FFR data were analyzed. The patients were classified according to the median values of pre-PCI FFR (0.71) and post-PCI FFR (0.88). The primary outcome was target vessel failure (TVF) at 2 years. Results: The risk of TVF was higher in the low pre-PCI FFR group than in the high pre-PCI FFR group (hazard ratio, 1.82; 95% confidence interval, 1.15-2.87; p=0.011). In 4 group comparisons, the cumulative incidences of TVF at 2 years were 3.8%, 4.1%, 4.8%, and 10.2% in the high pre-/high post-, low pre-/high post-, high pre-/low post-, and low pre-/low post-PCI FFR groups, respectively. The risk of TVF was the highest in the low pre-/low post-PCI FFR group among the groups (p values for comparisons <0.05). In addition, the high pre-/low post-PCI FFR group presented a comparable risk of TVF with the high post-PCI FFR groups (p values for comparison >0.05). When the prognostic value of the post-PCI FFR was evaluated according to the pre-PCI FFR, the risk of TVF significantly decreased with an increase in post-PCI FFR in the low pre-PCI FFR group, but not in the high pre-PCI FFR group. Conclusions: Pre-PCI FFR was associated with clinical outcomes after PCI, and the prognostic value of post-PCI FFR differed according to the pre-PCI FFR.

• 정보과학회 논문지
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• 제43권4호
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• pp.419-429
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• 2016

최근 관상동맥 영역화 결과로부터 삼차원 표면 모델을 생성함으로써 혈관 구조적 정보의 렌더링 효율성의 증대뿐만 아니라 전산유체역학를 이용한 혈류 역학 시뮬레이션을 통해 혈류분획예비력과 같은 생리적 정보들을 획득하는 연구들이 활발히 진행되고 있다. 본 논문에서는 혈관 영역화 과정에서 획득한 혈관 구조 정보를 입력 데이터로 사용하여 관상동맥의 삼차원 삼각 표면 메쉬 모델을 생성하는 방법을 제안한다. 관상동맥 영역화 결과로부터 삼각형 표면 메쉬 모델을 만드는 방법으로는 Marching cube 알고리즘에 기반한 방법들이 있지만 이산적인 영상 공간에서 수행되는 알고리즘으로 가늘고 다양한 굴곡을 갖는 혈관 경계를 표현하기 힘들다. 제안된 방법은 관상동맥 영역화 과정에서 추정한 혈관 중심좌표와 법선 벡터 그리고 직경 정보를 이용하여 기존 방법들보다 정교하게 단일 혈관 가닥들에 대한 삼각 표면 메쉬들을 생성하고 분기가 일어나 중첩되는 메쉬들은 메쉬 병합 기법을 사용하여 처리함으로써 통합된 관상동맥 메쉬를 생성한다.